Topics in Geriatrics: Resistance Training and Fall Risk Reduction for Older Adults
Individuals who are older fall for a number of reasons. This summary seeks to provide evidence-based resistance training guidelines for older adults, as resistance training has been shown to reduce fall risk across a number of outcome measures.
Objectives: 1) Learn about the relationship between sarcopenia and fall risk 2) Learn evidence-based approaches to resistance training for older adults 3) Learn the importance of trunk strengthening in relation to balance and fall prevention 4) Learn about resistance training and balance for older patients with peripheral neuropathy 5) Learn about the effect of plantar/dorsiflexion strengthening on balance in older adults
Information about the Condition
A decline in muscle mass is a common attribute of aging.(1) A progressive loss of muscle and function associated with aging is called Sarcopenia.(2) Sarcopenia has been associated with an increase in fall risk in the older population.(2) Some evidence suggests that resistance training as little as once per week may be enough to offset the muscle loss common in sarcopenia.(3)
Evidence for Use of Resistance Training in the Elderly
Fall risk has been associated with difficulty rising from a chair, carrying 10 pounds, leg strength, standing and walking balance, and diminished lower extremity muscle mass.(4) In addition, Maximal isometric strength has been shown to correlate with the maximal walking speed of older men and women.(5) Many of these deficits can be addressed directly and indirectly by physical therapists through resistance training with older adults.
Lee et al.(6) determined that in healthy older adults without cognitive deficits, improvements were seen in 30 second sit-to-stand, 2-minute step in place and limits of stability. In another study, combining resistance training with balance training demonstrated the greatest improvements.(7) Targeted resistance training has been shown to be beneficial in fall risk reduction as well. For instance, a systematic review by Granacher et al.(8) determined that trunk strengthening and stability is important for activities of daily living and may improve lower extremity function in elderly individuals.
Tofthagen et al.(9) note that resistance and balance training is safe and effective for helping reduce fall risk for older adults with peripheral neuropathy. In older adults living in an institution, a low-cost option requiring a relatively short duration of treatment (15 minutes including warm-up and cool-down) focusing on plantar/dorsiflexion was shown to improve strength and functional mobility.(10)
Evidence-Based Suggestions for Resistance Training to Reduce Fall Risk: For healthy older adults without cognitive deficits:(6,7) I)Train patients for 12 weeks, 2 sessions each week(6,7) II)Warm-up appropriately and maintain an intensity the 1st week – 45-55% of 1RM(6,7,10) III)Progressively increase resistance up to 65-75% of 1RM at 11-12 weeks(6) o Do not progress difficulty until the patient is able to complete all desired repetitions and sets with good form(10) IV)Complete 3 sets of 8-12 repetitions(6,7,10) V)Rest 60-120 seconds between sets(6,7) VI)In prescribing resistance exercise, mainly address trunk and lower extremity exercises at the hip, knee, and ankle dorsi/plantarflexion(6,7,8,10)
References: 1)Tyrovolas S, Koyanagi A, Olaya B et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study. Journal of Cachexia, Sarcopenia and Muscle. 2015;7(3):312-321. doi:10.1002/jcsm.12076.
2)Senior H, Henwood T, Beller E, Mitchell G, Keogh J. Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas. 2015;82(4):418-423. doi:10.1016/j.maturitas.2015.08.006.
3)Sousa N, Mendes R, Abrantes C, Sampaio J, Oliveira J. Is Once-Weekly Resistance Training Enough to Prevent Sarcopenia?. Journal of the American Geriatrics Society. 2013;61(8):1423-1424. doi:10.1111/jgs.12387.
4)De Rekeneire N, Visser M, Peila R et al. Is a Fall Just a Fall: Correlates of Falling in Healthy Older Persons. The Health, Aging and Body Composition Study. Journal of the American Geriatrics Society. 2003;51(6):841-846. doi:10.1046/j.1365-2389.2003.51267.x.
5)Rantanen T, Era P, Heikkinen E. Maximal Isometric Strength and Mobility among 75-year-old Men and Women. Age and Ageing. 1994;23(2):132-137. doi:10.1093/ageing/23.2.132.
6)Lee IPark S. Balance Improvement by Strength Training for the Elderly. J Phys Ther Sci. 2013;25(12):1591-1593. doi:10.1589/jpts.25.1591
7)de Bruin EMurer K. Effect of additional functional exercises on balance in elderly people. Clinical Rehabilitation. 2007;21(2):112-121. doi:10.1177/0269215506070144.
8)Granacher U, Gollhofer A, Hortobágyi T, Kressig R, Muehlbauer T. The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review. Sports Med. 2013;43(7):627-641. doi:10.1007/s40279-013-0041-1.
9)Tofthagen C, Visovsky C, Berry D. Strength and Balance Training for Adults With Peripheral Neuropathy and High Risk of Fall: Current Evidence and Implications for Future Research. Oncology Nursing Forum. 2012;39(5):E416-E424. doi:10.1188/12.onf.e416-e424.
10)Ribeiro F, Teixeira F, Brochado G, Oliveira J. Impact of low cost strength training of dorsi- and plantar flexors on balance and functional mobility in institutionalized elderly people. Geriatrics & Gerontology International. 2009;9(1):75-80. doi:10.1111/j.1447-0594.2008.00500.x.
Individuals who are older fall for a number of reasons. This summary seeks to provide evidence-based resistance training guidelines for older adults, as resistance training has been shown to reduce fall risk across a number of outcome measures.
Objectives:
1) Learn about the relationship between sarcopenia and fall risk
2) Learn evidence-based approaches to resistance training for older adults
3) Learn the importance of trunk strengthening in relation to balance and fall prevention
4) Learn about resistance training and balance for older patients with peripheral neuropathy
5) Learn about the effect of plantar/dorsiflexion strengthening on balance in older adults
Information about the Condition
A decline in muscle mass is a common attribute of aging.(1) A progressive loss of muscle and function associated with aging is called Sarcopenia.(2) Sarcopenia has been associated with an increase in fall risk in the older population.(2) Some evidence suggests that resistance training as little as once per week may be enough to offset the muscle loss common in sarcopenia.(3)
Evidence for Use of Resistance Training in the Elderly
Fall risk has been associated with difficulty rising from a chair, carrying 10 pounds, leg strength, standing and walking balance, and diminished lower extremity muscle mass.(4) In addition, Maximal isometric strength has been shown to correlate with the maximal walking speed of older men and women.(5) Many of these deficits can be addressed directly and indirectly by physical therapists through resistance training with older adults.
Lee et al.(6) determined that in healthy older adults without cognitive deficits, improvements were seen in 30 second sit-to-stand, 2-minute step in place and limits of stability. In another study, combining resistance training with balance training demonstrated the greatest improvements.(7) Targeted resistance training has been shown to be beneficial in fall risk reduction as well. For instance, a systematic review by Granacher et al.(8) determined that trunk strengthening and stability is important for activities of daily living and may improve lower extremity function in elderly individuals.
Tofthagen et al.(9) note that resistance and balance training is safe and effective for helping reduce fall risk for older adults with peripheral neuropathy. In older adults living in an institution, a low-cost option requiring a relatively short duration of treatment (15 minutes including warm-up and cool-down) focusing on plantar/dorsiflexion was shown to improve strength and functional mobility.(10)
Evidence-Based Suggestions for Resistance Training to Reduce Fall Risk:
For healthy older adults without cognitive deficits:(6,7)
I)Train patients for 12 weeks, 2 sessions each week(6,7)
II)Warm-up appropriately and maintain an intensity the 1st week – 45-55% of 1RM(6,7,10)
III)Progressively increase resistance up to 65-75% of 1RM at 11-12 weeks(6)
o Do not progress difficulty until the patient is able to complete all desired repetitions and sets with good form(10)
IV)Complete 3 sets of 8-12 repetitions(6,7,10)
V)Rest 60-120 seconds between sets(6,7)
VI)In prescribing resistance exercise, mainly address trunk and lower extremity exercises at the hip, knee, and ankle dorsi/plantarflexion(6,7,8,10)
Additional Resources:
1) http://acsm.org/docs/current-comments/resistancetrainingandtheoa.pdf
2) http://www.cdc.gov/physicalactivity/basics/older_adults/index.htm
3) http://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf
4) https://www.youtube.com/watch?v=vG6sJm2d4oc
5) http://www.exrx.net/WeightTraining/Weightlifting/Masters.html
References:
1)Tyrovolas S, Koyanagi A, Olaya B et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study. Journal of Cachexia, Sarcopenia and Muscle. 2015;7(3):312-321. doi:10.1002/jcsm.12076.
2)Senior H, Henwood T, Beller E, Mitchell G, Keogh J. Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas. 2015;82(4):418-423. doi:10.1016/j.maturitas.2015.08.006.
3)Sousa N, Mendes R, Abrantes C, Sampaio J, Oliveira J. Is Once-Weekly Resistance Training Enough to Prevent Sarcopenia?. Journal of the American Geriatrics Society. 2013;61(8):1423-1424. doi:10.1111/jgs.12387.
4)De Rekeneire N, Visser M, Peila R et al. Is a Fall Just a Fall: Correlates of Falling in Healthy Older Persons. The Health, Aging and Body Composition Study. Journal of the American Geriatrics Society. 2003;51(6):841-846. doi:10.1046/j.1365-2389.2003.51267.x.
5)Rantanen T, Era P, Heikkinen E. Maximal Isometric Strength and Mobility among 75-year-old Men and Women. Age and Ageing. 1994;23(2):132-137. doi:10.1093/ageing/23.2.132.
6)Lee IPark S. Balance Improvement by Strength Training for the Elderly. J Phys Ther Sci. 2013;25(12):1591-1593. doi:10.1589/jpts.25.1591
7)de Bruin EMurer K. Effect of additional functional exercises on balance in elderly people. Clinical Rehabilitation. 2007;21(2):112-121. doi:10.1177/0269215506070144.
8)Granacher U, Gollhofer A, Hortobágyi T, Kressig R, Muehlbauer T. The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review. Sports Med. 2013;43(7):627-641. doi:10.1007/s40279-013-0041-1.
9)Tofthagen C, Visovsky C, Berry D. Strength and Balance Training for Adults With Peripheral Neuropathy and High Risk of Fall: Current Evidence and Implications for Future Research. Oncology Nursing Forum. 2012;39(5):E416-E424. doi:10.1188/12.onf.e416-e424.
10)Ribeiro F, Teixeira F, Brochado G, Oliveira J. Impact of low cost strength training of dorsi- and plantar flexors on balance and functional mobility in institutionalized elderly people. Geriatrics & Gerontology International. 2009;9(1):75-80. doi:10.1111/j.1447-0594.2008.00500.x.